Prevalence and incidence of cholelithiasis in patients with liver cirrhosis.
OBJECTIVE
To evaluate the prevalence, the incidence and the history of cholelithiasis in liver cirrhosis.


METHODS
A series of 233 consecutive cirrhotic patients (193 Child A, 35 Child B and 5 Child C) were assessed for cholelithiasis by ultrasonography. Of these, 201 (those who had never had cholecystectomy) were followed-up with repeated ultrasonographies.


RESULTS
The prevalence of cholelithiasis was 38% (22% gallstones and 16% previous cholecystectomies). No relationships with the usual risk factors for cholesterol gallstones, such as age, sex, body mass index, serum glucose or triglycerides, were found. On the contrary, close correlations were observed with serum albumin, bilirubin, prothrombin time and Pugh score. By multivariate analysis, only serum bilirubin was independently correlated with cholelithiasis. Histories of biliary pain were more frequent in patients with previous cholecystectomy (62% cases) than in those with gallstones (21%) and those without cholelithiasis (7%). On the contrary, complaints of dyspepsia were similar in the three groups of patients. During a mean follow-up of 34.4 +/- 0.9 months, there was a 4.9% annual rate of development of new stones in 127 patients without cholelithiasis at the first investigation. This rate is markedly higher than that reported for normal subjects in a previous survey carried out in a similar geographic area. During a mean follow-up of 31.8 +/- 1.2 months, symptoms or complications were seen in 2 out of 45 patients with initial gallstones (4.4%). The annual rate of complications was estimated to be less than 2%.


CONCLUSIONS
Cholelithiasis is frequently associated with cirrhosis and the risk of developing new stones remains high during the natural history of the disease.
Maggi
A
A
Department of Internal Medicine, Centre for the Study of Liver Disease A. Migliavacca, University of Milan, Italy.
Solenghi
D
D
Panzeri
A
A
Borroni
G
G
Cazzaniga
M
M
Sangiovanni
A
A
De Fazio
C
C
Salerno
F
F
D001663:Bilirubin / Q000097:blood; D015992:Body Mass Index; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography
D001663:Bilirubin